A doctor was arrested on December 13, 2018 for improperly distributing opioids to his patients and billing Medicare for the drugs. The doctor now faces 45 federal charges relating to healthcare fraud for not only prescribing illicit drugs to patients but requiring those with insurance to accept injections so that he could bill additional costs to public health programs like Medicare. While this is an extreme example of pharmaceutical fraud, there are numerous smaller incidents of pharmaceutical fraud that take place every day. If you believe your employer or healthcare provider is engaging in pharmaceutical fraud or any type of healthcare fraud, contact the qui tam attorneys at Willoughby Brod immediately to report the fraud.

What is Pharmaceutical Fraud?

Pharmaceutical fraud involves illegal actions that pharmaceutical companies engage in that violate the False Claims Act (FCA) or California False Claims Act (CFCA) and result in false claims to insurers and Medicare/Medicaid.

One mistake that many Medicare recipients make is assuming that all their basic medical needs are covered under Medicare. In fact, there are a lot of commonly needed medical services that Medicare does not pay for. By becoming informed about the coverage gaps in your Medicare policy, you are not only preventing yourself from any surprises when you receive your healthcare bill, you are also increasing your ability to detect any fraudulent billing schemes from your healthcare provider or anyone else who tries to tell you that services not covered by Medicare are actually covered. If you do detect any violations by your healthcare provider or employer relating to Medicare billing, contact the whistleblower attorneys at Willoughby Brod immediately.

Dental Care

Even though every individual requires regular dental cleanings, and many Medicare recipients find themselves requiring dentures, Medicare does not pay for these basic dental needs. The only dental care that Medicare may pay for is dental care required while hospitalized as a result of an emergency.

As a whistleblower who has filed a qui tam case, your goal is to convince the government to prosecute your case. However, this is usually not an easy task. In fact, there are many situations in which the government may choose to dismiss your False Claims Act (“FCA”) claim, and the Department of Justice (“DOJ”) has outlined seven circumstances under which your qui tam claim may be dismissed. If you believe you have a strong qui tam claim, contact the qui tam attorneys at Willoughby Brod today to learn more about the strength of your case and your options moving forward.

False Claims Act

Section 3730(c)(2)(A) of the False Claims Act provides the following: “The Government may dismiss the action notwithstanding the objections of the person initiating the action if the person has been notified by the Government of the filing of the motion and the court has provided the person with an opportunity for a hearing on the motion.”

During this final week of Medicare open enrollment, you may receive multiple calls each day regarding your Medicare coverage. Many of these calls may be scams, and unless you know exactly what to watch out for, these scams can be difficult to spot. Make sure you follow the guidelines below and report any Medicare fraud you detect to the proper agencies. If you believe your employer or healthcare provider is the one committing the fraud, contact the qui tam attorneys at Willoughby Brod to learn how you can report the fraud and receive an award for your tip.

Four Tips for Avoiding Medicare Scams

Do not give out your Medicare number to anyone other than your doctor or someone who should have it.

While whistleblowers sometimes get a bad rap as “snitches,”the opposite in fact is true. By revealing their employers’ illegal actions, whistleblowers help society in ways that only whistleblowers can. If you have any doubts about whether you should blow the whistle on your employer’s illegal actions, contact the whistleblower attorneys at Willoughby Brod today to learn more about the ways in which whistleblowers help society and the ways in which you can contribute to that cause.

Whistleblowers help citizens save money.

From 1986-2016, recoveries made from whistleblower cases under the False Claims Act alone totaled over $28 billion. That is $28 billion that could have ended up in the hands of fraudsters rather than back in citizens’ pockets. By blowing the whistle on fraudulent acts, whistleblowers not only protect those who are directly harmed by the fraud but also send a message to fraudsters that the actions they wish to engage in are unacceptable and will not go undetected.

One of the most common types of healthcare fraud in violation of the False Claims Act (FCA) is pharmaceutical fraud. It is also one of the most highly reported types of healthcare fraud, with over $4.5 billion of financial penalties issued from qui tam lawsuits in 2012 alone. While whistleblowers are important to the healthcare industry in general, it is clear that their contribution to the pharmaceutical sector has been huge. If you suspect that you have witnessed pharmaceutical fraud, contact the qui tam attorneys at Willoughby Brod today to learn more about your options moving forward.

What is Pharmaceutical Fraud?

Pharmaceutical fraud involves illegal actions that pharmaceutical companies engage in that violate the FCA or CFCA and result in false claims to insurers and Medicare/Medicaid. There are several predominant types of pharmaceutical fraud, which are highlighted below.

There is no such thing as “good” fraud, but on the hierarchy of Medicare fraud from bad to worst, hospice fraud is arguably one of the most despicable types. Medicare Part A covers hospice care for patients who are “terminally ill,” or have a life expectancy of six months or less. If you believe you have witnessed hospice fraud, make it your duty to report the fraud and honor an individual’s last moments in this world. The whistleblower attorneys at Willoughby Brod are experienced at helping whistleblowers bring their claims forward and protecting them in the process. Contact us today for a free consultation and to learn how we can help.

What Does Medicare Provide by Way of Hospice Care?

As mentioned above, Medicare Part A covers hospice care for patients who are deemed by a medical professional to be terminally ill, which is defined as having a life expectancy of six months or less. Medicare covers only hospice care for terminally ill patients and not any curative treatments, although hospice patients can continue to receive curative care coverage for conditions unrelated to the cause of their terminal illness.

One common concern that holds people back from becoming whistleblowers is the fear that they will face discipline for being involved in the same fraud they are now reporting. Sometimes employees feel coerced by their employer into partaking in fraudulent actions, and other times the employee may have been the one to spearhead the fraud. In both cases, if you have had a change of heart, and not only do you no longer wish to participate in the fraud, but you want to put an end to it altogether, contact the qui tam attorneys at Willoughby Brod today to learn more about what steps you should take next.

When You Participated in the Fraud but Did Not Spearhead it

Both the False Claims Act (FCA) and the California False Claims Act (CFCA) want to afford whistleblowers the maximum protection possible so as not to deter people from coming forth as a whistleblower. Therefore, in most circumstances, a whistleblower who partook in the fraudulent act they are now reporting will not face any penalties for participating in the fraud.

One common category of healthcare fraud schemes in the medical laboratory industry revolves around medically unnecessary testing. There are many different ways in which the medical laboratory industry fraudulently commits medically unnecessary testing, which are highlighted below. If you believe you have witnessed healthcare fraud involving medically unnecessary testing, contact the healthcare fraud attorneys at Willoughby Brod to learn more about what you should do next.

What is Medically Unnecessary Testing?

Medically unnecessary testing occurs when clinical laboratories order tests that are excessive, unnecessary, or inappropriate for a patient’s treatment. Not only can this be extremely costly, it can also be dangerous to a patient’s life.

Though similar in purpose, the Anti-Kickback Statute (AKS) and Stark Law have many differences that are often overlooked or ignored by the general public. If you believe you have witnessed a form of healthcare fraud but are unsure whether the fraudulent act was a violation of the AKS or Stark Law, contact one of the experienced AKS and Stark Law attorneys at Willoughby Brod today for your free case review.

What is the Anti-Kickback Statute?

The AKS provides that physicians and hospitals are not permitted to refer patients to other healthcare providers in exchange for something of value, whether in cash or another form. The purpose of this statute is to ensure that referrals are genuine and based on merit rather than based on familial or professional networks.